Predicting catastrophic health events - noninvasively and short term

"I've just picked up a fault in the AE35 unit. It's going to go 100% failure in 72 hours". These were famous words of the almighty computer HAL in "2001: A Space Odyssey". Few of us believe too much in software forecasts - be it weather, earthquakes or computer hard disk failures. Yet, we all know that sometimes it works. And such systems are very valuable, assuming they continuously improve.

Word cloud generated from QS #15 intros

Wellness is always a common theme of the many presentations and experiments of Quantified Self enthusiasts - citizen scientists quantifying everyday life in order to improve it.  "Health" was the most frequent word among the two-word introductions of QS #15 attendees, followed by variations of sleep and happiness, and ways to measure and understand it.
Are health failures predictable?  Nobody argues they are, although most available services  - such as genomic testing - provide only long term predictions.  Biomarkers that scientists are interested in are obtained through invasive or costly interventions - like blood proteins or intracranial electroencephalograms. Technologies such as Mobile Cardiac Outpatient Telemetry™ (MCOT™) developed by CardioNet  are based on real time EKG focused on heart rhythm abnormalities that can't be detected in small 24 or 48 hour windows. These relatively rare events are correlated with symptoms and used for diagnostics.

Your husband just died, … here’s his black box
(from Gordon Bell's presentation)

Perhaps in the future every one of us will leave a black box holding all the truth about our health, helping next generations to better maintain, test and repair their bodies. Many lives have already contributed to the understanding of causes and effects such as the link between cholesterol levels, diet and heart attack. But what about the short term prediction horizon,  like the 72-hour window of HAL or 30 seconds to 15-to-45 minutes warning by seizure dogs?
Could computer luminary Gordon Bell predict his heart attack if he wore his heart monitor strap while bicycling?  A cardiologist would say "no way", but maybe sometimes it's better to keep quantifying and experiment despite of what medical establishment has to say?
Data from the Women’s Health Initiative study (129,135 postmenopausal women observed over a period of nearly eight years) show that a woman’s resting heart rate may be a good indicator of her risk for a heart attack. Hsia and others (2009) found that women whose resting heart rate is more than 76 beats per minute are significantly more likely to have a heart attack than women with resting heart rate less than 62 beats a minute. This risk factor is particularly strong for women between the ages of 50 and 64, less so for women over the age of 65. (Trial NCT00000611)

Of course, women have different kinds of heart attacks than men do. They are more likely to die from a spasms of heart and the blood vessels leading to the heart, and are more likely to complain of fatigue and sleep disturbances in the weeks and months leading up to a heart attack. Sleep disturbances and decreased physiological differences between day and night are increasing heart attack and stroke risks for males too, at least for shift workers. Exercise tests  - known for their false positive results - have better cardiovascular prognostic value for smokers with high cholesterol than healthy men.

Finger arterial pulsatile volume changes or finger blood flow - related to blood pressure - is another medium-to-long term predictor of pending cardiac events. A simple, noninvasive finger sensor test called EndoPAT  can predict major cardiac events such as a heart attack or stroke for people who are considered at low or moderate risk.

AngelMed Guardian System (inventor: Dr. Tim Fischell) is an early warning system - telling 24 hrs to a week before if heart attack is coming. Average time between the cardiac event and hospital arrival is 3 hrs, and about 5 hrs before the surgery starts. By that time 90% of muscles could be dead, so 5 or 10 minute warnings could save lives.  Unfortunately, Guardian is highly invasive - sized as an iPod, it is implanted directly into the patient's chest, monitoring electrogram  waveforms and other crucial heart-signal data 24-7.

Many portable oximeters and ECG are already in the market - and even though consumers are complaining about noise and difficulties in getting readings of diagnostic intervals, the technologies will continue to improve and self-quantifiers will be finding solutions for better health.

REFERENCES
Hsia, J., Larson, J., Ockene, J., Sarto, G., Allison, M., Hendrix, S., Robinson, J., LaCroix, A., Manson, J., & , . (2009). Resting heart rate as a low tech predictor of coronary events in women: prospective cohort study BMJ, 338 (feb03 2) DOI: 10.1136/bmj.b219


Mayo Clinic (2009). High resting heart rate could predict heart attack in women. Mayo Clinic women's healthsource, 13 (7) PMID: 19498326

The Benefits of Exercise

Image by mikebaird via Flickr

Execise is good. It can halve your risk of developing many major illnesses (including type 2 diabetes, coronary heart disease, osteoporosis, cancers - e.g., it protects against bowel cancer; for older women, it may cut breast cancer risk). Benefits of regular exercise include increasing levels of HDL ('good' cholesterol) and reducing high blood pressure. It promotes bone density to protect against osteoporosis, improves sleep, reduces stress and risk of depression and dementia later in life.


Daily Exercise is good for you

On M-Health, Wireless Health and Smart Plasters

M-health or mobile health is a recent term for mobile devices supporting medical practice. This term is closely related to Telemedicine (coined in the 1970s) and to another recently introduced term wireless health.

Aurametrix wrote about exciting health gadgets and devices in several last year's blogs (such as Telemedicine: part 1, Telemedicine: part 2, Devices to keep you healthy, Going for the piece of a healthcare pie)

Many companies - large and small -make use of wireless sensors to collect clinically-actionable data for point-of-care. Companies including GE, Cinterion, Cardionet, Heatlhsmart, Digi, RIM, Proteus, E-Device, MedApps, are now working in mobile health area offering products and developing prototypes. Check, for example T+ Medical, Turkcell's Saglik365, Orange's Diabeo, Telstra's My-Glucose, Cardionet's MCOT™, and numerous cell phone applications (as some people say, the Phone will become your doctor) such as Allscripts remote. And there will be many more exciting developments - portable wearable devices scanning brain for signs of depression & stress disorders,

Everyday choices determine your health better than genomics. In addition to exciting gizmos and wearable monitors measuring activity, heart rate, sleep patterns, some companies are working on tiny implantable sensors helping to monitor health and health-related behaviors.
Proteus Biomedical is implanting tiny sensors into pills that send signals translatable into messages - such as "just took lipitor at 6:20pm" - sent in a very safe and private way to a wearable plaster, or a smart-band aide. This smart plaster is also picking up information on health-related measurements such as your heart rate, breathing patterns, activity level, stress, respiration
get sends you reminders. Last September Novartis worked with Proteus on a small 20 patient study to track patients’ compliance with their blood pressure drug regimen. This year the companies will work on sensor technology in organ transplantation.


American tech companies, taking notice of the unmistakable demographic trends, have launched a surge in gudgets for aging population - dubbed the silvertech. Emergency alert services have become a proliferating category in silvertech, along with sensor systems for the home, various kinds of long-distance health monitoring and smart medication dispensers that provide reminders and control dosage. Some dispensers signal a caregiver when a dose isn’t taken or a pharmacy when it’s time for a refill.

GE scientists are developing wearable RFID sensors to detect airborne chemical agents - to alert people to the presence of environmental chemical agents in the air. A novel technology based on resonant antenna structures of RFID sensors coated with various sensing films will recognize specific volatile organic compounds (VOCs) and chemical agents with part-per-billion detection limits. The sensor could also be used to analyze a person’s breath. Simply breathing on the sensor could potentially pick up biomarkers that serve as an early signal to the presence of certain diseases such as diabetes or cancer and metabolic disorders.

Non Invasive Health Monitoring with mHealth

View more documents from Bart Collet.

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• GE's wearable sensors would warn of hazards in the air (timesunion.com)
• Electronic Nose Sniffs out Toxins (nih.gov)
• Study shows how carbon nanotubes can affect lining of the lungs (scienceblog.com)
• Daily Dose: There's BPA in That? (dailywd.womansday.com)
• Wearable RFID Sensors being developed (ubergizmo.com)
• The new healthcare: Smart band aids, digital pills, wrist bands promise to track your health (venturebeat.com)
• In Health Care Today, It's Electronic All the Way (nlm.nih.gov)
• mHealth, Alpha Daughters and Healthcare Reform (prweb.com)

Telemedicine, Part II

Read Part I

Telehealth Monitoring Wristwatches

The first reported person to actually wear a watch on the wrist was the French mathematician and philosopher, Blaise Pascal (1623-1662). With a piece of string, he attached his pocket watch to his wrist. In the late 1800s, the wrist watch was officially invented by the Swiss watch maker, Patek Phillippe. The first wristwatch for men was designed by Louis Cartier in the early 1900s. Ranging in price from less than $30 to $400 and more, a variety of real heart rate monitors are available in the market. Suunto, for example, can calculate metrics like oxygen consumption, respiratory rate and training effect. On the lower end, the Omron HR-100C is easy to use and doesn't have a lot of fancy functions to confuse novices, measuring heart rate with a chest strap and… transmitting data to the wrist-mounted display. If you want more features than the basics, reviewers recommend the Polar F11 heart rate monitor. The Garmin 305 (image on the right) has an integrated GPS antenna, so unlike most heart rate monitors, it can tell how far and how fast you're going.

An iPhone Blood Pressure WebApp by Bit&Becker will monitor your blood pressure over several periods of time. It will also show your Max/Min and Average Systolic, Diastolic Bloodpressure, as well as your Pulse. You can export your data in CSV (Excel) Format. Current version of Blood pressure monitoring devices has now support for extreme high and low blood pressure values. And no more google ads, to keep your blood pressure low.

Animas Corporation, which is now a Johnson & Johnson company, is no longer
longer selling the current model GlucoWatch G2 Biographer System, shown on the right. Cygnus Inc. (Redwood City, California) is already working on second and third generation products that will overcome some of limitations of this watch which include skin irritation and calibration, meaning additional finger-stick tests redone about 20% of the time.

TeleMedIS System combining the TeleMed HC Platform developed by Karolinska and Telehealth Monitoring Wristwatch (TMW) developed by Tadiran LifeCare, connected over the Wireless Network (provided by TeliaSonera Sweden), is able to measure user vital signs by using integrated biosensors. This includes 1-lead ECG, Blood oxygen saturation level (SpO2), Pulse (heart rate)

Victorian researchers have developed a wristwatch that continuously monitors the health status of people with Parkinson’s disease to help doctors manage their treatment, Victorian Minister for Innovation Gavin Jennings said in May 19th press release. The wristwatch, which is still at the prototype stage, was introduced onto the world market by Mr Jennings at BIO2009 in Atlanta, USA.

Dreamate Sleep Inducer is a non-invasive sleeping aid wristband. This watch-sized device on a strap uses acupressure techniques to “retune the biological clock and train your body to relax and sleep by massaging key acupoints on your inner wrist". The Taiwanese gadget provides a double-frequency micro-massage (via a vibration motor) to specific pulse points—termed the “Sleeping Golden Triangle” points in traditional Chinese medicine. The company says it helps in relieving stress, inducing sleep and is especially beneficial for people suffering from jet lag.

Health equipment manufacturers such as Omron Healthcare Co Ltd, Nipro Corp, and Matsushita Electric Works Ltd, all of Japan, have been announcing terminals to measure physical activity. These "life recorders" are specifically designed to make it possible to accurately measure the amount of physical activity, pulse, skin temperature and motion. They also measure external factors such as atmospheric pressure.

If you wear the GoWear fit armband during the course of your day, then log onto your personalized GoWear fit online activity manager, you’ll get information about the calories you’ve burned, plus a calorie consumption calculator and tips for how to best reach your fitness and lifestyle goals. GoWear fit also measures sleep duration and efficiency – so that you can begin to understand the influence your bedtime has on your overall health
And if you do not want the world to know what exactly you are measuring, consider design suggested by Hironao Tsuboi for an LED watch. It looks like just a metal band. Push a button, and you get the time or what you'd like to get. Don't push the button: no numbers, no curves, no pie charts. Very simple.

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See also Devices To Keep you Healthy

Aurametrix is working on tools to help you evaluate your personal health risks and benefits and make the right choices.